title: Vein graft failure.
abstract: After the creation of an autogenous lower extremity bypass graft, the vein must undergo a series of dynamic structural changes to stabilize the arterial hemodynamic forces. These changes, which are commonly referred to as remodeling, include an inflammatory response, the development of a neointima, matrix turnover, and cellular proliferation and apoptosis. The sum total of these processes results in dramatic alterations in the physical and biomechanical attributes of the arterialized vein. The most clinically obvious and easily measured of these is lumen remodeling of the graft. However, although somewhat less precise, wall thickness, matrix composition, and endothelial changes can be measured in vivo within the healing vein graft. Recent translational work has demonstrated the clinical relevance of remodeling as it relates to vein graft patency and the systemic factors influencing it. By correlating histologic and molecular changes in the vein, insights into potential therapeutic strategies to prevent bypass failure and areas for future investigation are explored.
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California San Francisco Medical Center, San Francisco, Calif. Electronic address: christopher.owens@ucsfmedctr.org.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Owens
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California San Francisco Medical Center, San Francisco, Calif.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Gasper
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California San Francisco Medical Center, San Francisco, Calif.
authors.forename: Amreen S
authors.initials: AS
authors.lastname: Rahman
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California San Francisco Medical Center, San Francisco, Calif.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Conte
mesh_terms: D000818:Animals; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D006965:Hyperplasia; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D058426:Neointima; D012307:Risk Factors; D013314:Stress, Mechanical; D013997:Time Factors; D017211:Treatment Failure; D058017:Vascular Grafting / Q000009:adverse effects* / Q000379:methods; D066253:Vascular Remodeling; D014680:Veins / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000637:transplantation*; D014945:Wound Healing